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Just one more question... or three...
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Old 08-08-2020, 02:46 AM
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Default Just one more question... or three...

It's summer, half the providers are on vacay so the messages/refills/paperwork is triple the usual, plus loads of patients who usually see someone else and are cranky about having to see a strange doctor. That's the baseline.

I had a bunch of physicals today, we're catching up on the backlog from well-care being suspended early in the pandemic. I always start off with "Any questions or concerns I can help you with, besides the physical? Anything your family told you to ask the doctor"? It's quite common for people to say "no" and then remember a question at the end of the appointment. It's called the "doorknob question", they ask when you have your hand on the door to leave. I had 3 of those today, no big deal. I'm old, I call them "Columbo" patients, after the TV detective of yore (see title of thread). Then there was this guy... boy was I glad I never signed off on his chart until he left...

He's in his very early 20's, has a very high-paying job in the IT field. He was in for a complete physical. He said, in the beginning when I asked if he had additional concerns, that he wanted to see a dermatologist for his skin. He'd been on potent meds for a skin condition, it had worked, his skin is clear now. He also thinks his hair is thinning, it's not. But he wanted a referral to derm. OK, champ, no problemo. I explain that if we do anything separate from the screening physical and routine labs, such as a referral, it generates an additional charge. He nods. I do the exam. Finish the chart note, type up the referral, type up the email request for a referral, print the visit summary, give it to him. Oh, he also wants a referral to a surgical sub-specialist for a second opinion on some minor surgery he recently had. He wants to go outside our hospital system, which is more involved. Re-open the chart note, add the problem, re-do the chart note to reflect this added problem. Do the outside-the-system referral. Ask if there's anything else. No, that's it. Print a new visit summary. Oh, I have anxiety. My sister wanted me to talk to you about my anxiety. Drag out the PHQ-9 and GAD-7 questionnaires, ask him the 16 questions, enter them into the computer, add the problem to his list, redo the chart note. He doesn't want meds or referral to therapy. Ask if there's anything else. No, that's it. Print a new visit summary, with how-to-deal-with-anxiety verbiage added. Oh, his mom told him to ask for a prescription for massage therapy because it's covered by insurance with a doctor's prescription. He hadn't complained of pain in his neck or back during the exam but now he wanted Rx for massage for neck and back. Reopen the chart note, add the problems, redo the note, type and print out the prescription. Ask if there's anything else. I'm now 25 minutes behind. No, that's it. I print a new visit summary and give it to him. Then he says, "Oh, my father told me you aren't supposed to charge for anything but the physical today". I told him, politely, that was not happening. I explained again that his physical is free under his insurance but problems, referrals, medications, prescriptions were separate from the physical and we have to charge for them. "But my dad said..." I said, "I'm sorry, I explained it to you, I don't have time now to discuss it further". I also politely but pointedly suggested that next time he comes in, he and his family create a list of all his questions. I apologized to the next patient for the delay, who barks at me "You know, my time is valuable too!!" Apologize again and start planning what adult beverage to consume once I get home...
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Last edited by skeptic53; 08-08-2020 at 02:49 AM.
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  #2  
Old 08-08-2020, 10:11 PM
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Quoth skeptic53 View Post
... Apologize again and start planning what adult beverage to consume once I get home...
I have a recommendation for that: All of them!
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Old 08-09-2020, 12:04 AM
earl colby pottinger earl colby pottinger is offline
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Quoth Ironclad Alibi View Post
I have a recommendation for that: All of them!
In which order, alphabetical, by volume or by alcohol content?
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Old 08-09-2020, 12:54 AM
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Quoth earl colby pottinger View Post
In which order, alphabetical, by volume or by alcohol content?
Nearest to furthest.
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Old 08-09-2020, 02:00 PM
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This guy probably does the same thing on phone calls into customer service centers. I hate people like that. Just as you wrap things up and are about to say "goodbye" to the customer, there's always "Oh, I just noticed..."
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Old 08-09-2020, 02:28 PM
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What I learned installing and servicing card access & video systems was that 90% of the work was introduced with, "Oh, by the way..."
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